MAYBE MULTIPLES IN COURTS AND CORRECTIONS
by
Ralph B. Allison,M.D.
California Mens Colony
San Luis Obispo, California
Presented at the Meeting of the
American Academy
of
Psychiatry and the Law
in
Ottawa, Ontario, Canada
October 15-18, 1987
Experience Outside Prison
I
For 16 years, I practiced psychotherapy in a private practice
setting and in county mental health clinics in California, while
doing forensic evaluations for courts and attorneys. In 1972, I
met my first patient with Multiple Personality Disorder (MPD).
This led to a decade of teaching, writing and consulting on
that subject. During that decade, I conducted forensic
evaluations of 13 men and women in whom there was a possibility
that they were multiple. Of that group 69% (N=9) went to
prison, 15% (N=2) were found not guilty of the crimes charged,
8% (N=l) were found not guilty by reason of insanity (NGI) and
sent to a state hospital and 8% (N=1) were put on probation.
I was able to follow the courses of three of the men who went
to prison The insane one was followed for 2 years, when he
returned to the community, subsequently becoming a subject for
the "60 Minutes" program with Mike Wallace.
Naturally, the primary concerns in evaluating these defendants
prior to trial has been to determine the answers to the
following questions:
1. Did they have a mental illness at all, or were they
malingering?
2. Was the mental illness MPD or something else, such as
schizophrenia?
3. Was the mental illness related to the criminal offense so
that an insanity plea could be logicallv supported?
4. If I thought the defendant had MPD, how could I demonstrate
the data supporting this opinion to the judge and jury so they
would understand the reasons behind my opinion?
In the majority of these cases, opinions and feelings about
amenability to treatment were set aside, since ultimate
disposition would be up to the judge and jury. In the only
case where the defendant was found NGI and sent to a state
hospital, two of us psychiatrists went to the hospital, oriented
and educated the treatment staff on what needed to be done and
conducted periodic re-examination of the patient until he was
released as integrated and no longer dangerous. We felt he
was eminently treatable, but not by the usual means used at the
hospital for their most commonly admitted patients.
II
Experience Inside Prison
For the past six years, I have been treating patients in a
medium security prison in Central California which is assigned
the responsibility for housing most of the State's inmates who
have a documented history of major mental illnesses but who are
able to function as outpatients. My case load has been
approximately 400 inmates, whom I saw in 10 sick calls a week.
When I came to work behind bars, I had seen a number of
multiples, 85% of them women and 15% men. Among those seen
only for court actions, the ratio was reversed. Therefore, I
expected to be able to find quite a few male multiples in the
prison. I also hoped to find out what could be done with them
after my forensic colleagues had finished their work and the
juries had found them sane and guilty. Such has not been the
case.
Since I do not have statistical information regarding those
patients I have seen in prison whom may have been dissociators
or multiples, I can only give you my rough impressions. Very
few of those with solid histories of dissociation had entered
pleas of NGI, so psychiatric evaluations were non-existent prior
to conviction. They had amnesia for the crimes but were clearly
responsible for the charged deed. They were so shocked at what
they had done, they pled guilty and offered no excuses. It was
only when I saw them at routine intake interview in prison that
the story came out which could support a long standing history
of MPD. They were not trying to escape punishment, but they
certainly wanted to know why they did the deed charged, so they
would never do it again. only one inmate admitted that he
totally fabricated a story of MPD on the advice of his attorney.
Obviously, no one bought it.
While I was in private practice, I treated a male multiple who
had spend most of the prior 20 years in one prison or another.
While there, he kept waking up in the prison hospital after
being in fights for which he had no memory. He knew he had done
wrong and that he had some sort of serious mental disorder.
When I asked him why he had never asked for psychiatric
treatment, he said, "Doc, in prison there are two kinds of
psychiatrists. The good ones are too busy with paperwork to
treat patients. I wouldn't waste my time with the others."
With this comment in mind, I attempted to keep the paperwork
under control while I spent the majority of my time seeing
patients.
As a result of the marked limitations inherent within the
system, I have only been able to treat one male multiple in the
standard fashion. He was convicted of bank robbery committed by
his alter-personality, which he had created in the image of his
father, a Mafia Don in Chicago. He had vowed never to be like
his father, so he became a Casper Milquetoast with hoodlum
alterpersonalities. Therapy consisted of teaching him to be
more assertive in everyday life, so his alter-personalities
didn't have reason to come out and avenge him after someone
walked all over him and his rights. This approach worked well,
and he paroled in an assertive but not aggressive state of mind
without any longer suffering blackouts during which he
intimidated others.
Another inmate I saw was one whom I had examined 10 years
before for an arson charge. He then spent two years in
California Youth Authority, and subsequently committed two
murders while intoxicated on alcohol and drugs. I had seen
what appeared to be an evil alter-personality during his days on
parole, but he would not let me testify at his trial because of
the fear I would reveal that he was also a voyeur. That would
have embarrassed him too much! He went to Death Row where he
had a psychotic break. His term was commuted to life, and I saw
him when he came to my prison on a routine transfer. I went
over his history with him trying to understand what I had seen
10 years before. He saw himself Primarily as an alcoholic. He
had not dissociated in prison, although he may have done so
while in CYA. He left our prison after trying to escape and
then putting out a contract on the life of the inmate who had
snitched on him. At that point, the best diagnosis was
Borderline Personality Disorder. Another inmate was
seen two years after conviction of murder so I could write "the
rest of the story." At the trial he showed a very evil
alter-personality who had killed his stepdaughter. I wanted to
find out if I had been led astray or if the same entities were
still present in the prison environment. We spent the visit in
a wire cage in the visiting room at San Quentin. With the
exception of one entity, a highly religious one, all of those
I had met in the county jail during the trial were still there.
The "Nice Guy" who would't hurt a flea was clearly the
favorite of the guards, who greeted him warmly when he came to
the visiting area. The "Killer" was still involved in all the
prison games such as drug smugglinq and gambling, as he had
been on the outside. The "Tattletale" who had informed me of
the gory details of the murder was working with his public
defender on his appeal of the death sentence. Each entity had a
necessary role to play in his prison life. Any psychotherapy
would have seemed to be contrary to his own best interest in
that environment.
III
Institutional Interferences with Treatment
When I started working in prison, I was encouraged to see
some inmates for traditional psychotherapy in individual hourly
sessions one to four times a month. The next year, the
Department of Corrections instituted a Work Incentive Program
which paid inmates in work or school assignments with
day-for-day credit on their terms. Work supervisors were
literally threatened with prison themselves it they let inmates
leave the work site to get medical attention. This forced
doctors into working evening so inmates could be seen after
leaving the shoe factory and before the evening lock up time.
For some workers, that meant 40 minutes was available for all
sick call. This effectively wiped out a large part of our
organized psychotherapy program and it has not yet recovered.
It did totally block my ability to schedule patients when I was
mentally fresh enough to deal with them.
At that time, I was transferred to a quad where the population
is made of up mostly chronic patients with major mental
illnesses. Some inmates came through with histories highly
suggestive of MPD, but I was too busy with triage of acute and
chronic psychotics to follow up on their cases. Fortunately. I
usually had one or two second year psycholoqy interns working
with me, and I could refer these "teaching cases" to them for
evaluation and treatment. But that is not the some as working
up .a problem patient by myself.
Another problem is that violent behavior by an inmate beyond a
certain point administratively leads to his transfer to an
institution with a higher security level and out of
psychotherapy of any kind. Also, for a doctor to talk to any
inmate in a total lockup situation awaiting such a transfer
requires the presence of two correctional officers wearing body
armor. They have many things to do besides stand there and
listen to the doctor talk to the inmate, so the doctor does not
feel free to spend an hour at the door of the patient's cell.
Likewise, the custody staff are not allowed to leave the
inmate/patient in the doctor's office without the same two
officers present in the room. This can be inhibiting for both
the patient and doctor.
I saw one young inmate, who clearly manifested
alterpersonalities, while he was in the Disciplinary Detention
Unit (DDU) because he had stomped on the head of another inmate.
No matter what I might do therapeutically to calm down the
personality who did the stomping, that behavior was all the
Warden needed to send him to a higher security prison. He did
go, and there the psychiatrist deemed him perfectly normal, in
spite of my exhaustive workup. He was sent to a general
population prison, where he did well because his most antisocial
personality was in charge most of the time. On parole, he
played football for his junior college. But his football player
personality became irate when the coach would not let him play
in games where big league scouts were known to be in
attendance. The coach had good reason, since, in practice,
another personality who didn't know the Plays often took over.
He stormed out of the coach's office in anger, blacked out,
leaving an antisocial personality in charge. This personality
robbed five banks before being caught. The capture occurred
because a new personality came out while leaving the last bank
and didn't know why he was carrying money bags down the street
being chased by shooting officers. He hid under a car instead
of running to the getaway vehicle.
At his arraignment in Federal Court, an attention getting
personality came out, dropped his pants, urinated on the floor
of the courtroom, barked like a dog and meowed like a cat. The
judge wisely suggested to the defense attorney that his client
might have a mental problem. The attorney asked him if he had
ever been treated by a psychiatrist and he give my name. I was
appointed to examine him for the court in Federal prison, which
I did, finding much the same clinical picture as I had found in
State Prison. He was found sane and guilty and sentenced to
Federal Prison for 12 years. A psychology intern there called
me to report that he created chaos there and was sent to the
Federal Prison Hospital but was sent him back as a malingerer.
By this time the inmate was giving the story that he had
studied drama in college and thus had learned how to play all
these Parts. You can see how such an inmate can tie up many
parts of the criminal justice system. We have much more to hear
from this young man, I am sure, when he paroles the next time.
IV
A New Breed of Dissociators?
After dealing with a number of neurotic patients with MPD who
did not go to prison, some who went to prison for non-lethal
felonies and those seen because of murder charges, I am coming
to the conviction that the neurotic ones may commit various
and sundry crimes while acting out their internal conflicts,
but they are highly unlikely to murder anyone. The only
exception might be when the victim has previously tried to
kill the multiple. But the murderers I have seen who had a
documented and reliable history of manifesting some type of
alter-personality have a number of unique factors not seen
in the neurotic, non-killer multiples.
These differences are not included in the DSM-III-R
definition of MPD, which does, superficially, describe
the murderer accurately as well as the neurotic multiples I
have treated. The definition is as follows:
"1. The existence within the person of two or more
distinct personalities or personality states (each with its own
relatively enduring pattern of perceiving, relating to, and
thinking about the environment and self).
2. At least two of these personalities or personality
states recurrently take full control of the person's behavior."
These are the unique characteristics which I have found in
murdering men who also met the above definition of MPD:
1. Origin of criminal entity: Whereas angry
alterpersonalities most frequently develop during the
course of overwhelming physical and/or emotional abuse by
a parental figure, a more frequent story in the murderers
is this: The little boy is locked in the closet by a hated
boyfriend of his mother while the boyfriend is sexually
molesting the boy's sisters. He can't do anything to
protect his sisters, and he asks in his head how he can kill
the boyfriend. A voice answers, "I will help you." That voice
is the first appearance of the criminal entity.
2. Relationship between the primary personality and the
criminal entity: Instead of the usual massive one-way
amnesia between the two entities, with the primary
personality having little or no direct awareness of the angry
alter-personality, as is usual in the neurotic multiples, in
the murderers there is an ongoing communicative relationship
between the two entities. it might be a teacher-student
relationship as in the man whose criminal entity spent many
hours teaching the primary personality the principles of the
Cabalistic religion (whatever that might be), to the point
that the primary personality listed that name in the
"Religion" box on his arrest and booking sheets.
3. First Psychiatric Examination for Court: When first
examined for possibility of MPD, most neurotic patients do
not know how to make contact with the negative
alter-personality which may force its way out against the
will of the primary personality sometime during the
interview. They have no first hand knowledge of the
alter-personality and do not believe anyone who tells them that
such a thing exists. The killers have been able to go inside
their heads and easily locate the criminal entity with no
trouble at all. If I tell one, "I'd like to meet the Joe you
told me about," he says, "Sure, I'll go get him." In a few
seconds, the face and body posture changes, and Joe is in
charge, telling you whatever he is willing to divulge of
his criminal career. Such facility in the ability to
change personalities comes about in neurotic multiples only
after months of hypnotherapy during which they get practice
at locating the alter-personalities and learning how to
open the door to consciousness. 4. The Killer's
Victim: I have had only one neurotic multiple who may have
killed someone and that was unproven. She remembered killing
her stepfather and his two friends after they had attempted to
kill her. Bodies were never found, so I don't know if her
memory was truth or fantasy. The killers I have seen for
trial killed persons who were not objects of revenge. One
mentioned before killed his seven year old stepdaughter, and
one killed the driver of a car in which he had hitched a ride.
Such senseless and irrational choices of victims make these
defendants very unsympathetic to juries.
5. Psychological Testing by Rorschach: There is a
pattern of responses to the Rorschach test which seems to
be typical of neurotic multiples, which has been described by
Wagner & Heise(1974). These killers do not show that same
pattern of response, but show a pattern which Wagner
considers more consistent with schizophrenia.
6. Criminal History of the Antisocial Entity: In
neurotic multiples, there are often alter-personalities who
do isolated illegal acts, when the primary Personality gets
angry and loses control of the body. But they don't seem to
have the ability to maintain a complex criminal lifestyle over
a long span of time. But in the killers, there has been
a documented criminal history of the type that required
recurrent association with the criminal subculture, with
gun smuggling, narcotic trafficking, arrests, court
appearances, jail time, etc., all managed by the criminal
entity. These acts may have been completely hidden from
the Primary personality who is convinced he has a clean
record. These acts were not done to embarrass the primary
personality, when he wakes up in jail, as is the common case
in neurotic multiples. The criminal entity is perfectly
willing to undergo the punishment of the criminal justice
system and not inflict it upon the passive primary personality.
V
Conclusions
With this paper I have tried to mention some of the
important factors that seem to exist when a "maybe multiple"
man comes to prison. I have covered the problems of
identifying and working up such patients in a busy prison
practice and the institutional problems of giving minimal
treatment. The problems of security and placement in
other institutions has been mentioned. Lastly, I have
tried to provide a thought provoker for those of you
who do frequent forensic evaluations of murderers. There
may be a group of maybe multiple murderers who have bona fide
histories of long standing dissociation, and who may need to
be given a new cubbyhole in DSM IV due to significant
differences in the clinical and dynamic characteristics
they demonstrate.
REFERENCE
Wagner, E.E., & Heise, M. A comparison of Rorschach records
of three multiple personalities. Journal of Personality
Assessment, 1974, 38, 308-331.
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